Low-value clinical practices in injury care: a scoping review protocol.
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ABSTRACT: Introduction
Preventable injuries lead to 200?000 hospital stays, 60?000 disabilities, and 13?000 deaths per year in Canada with direct costs of $20?billion. Overall, potentially unnecessary medical interventions are estimated to consume up to 30% of healthcare resources and may expose patients to avoidable harm. However, little is known about overuse for acute injury care. We aim to identify low-value clinical practices in injury care.Methods and analysis
We will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify research articles, reviews, recommendations and guidelines that identify at least one low-value clinical practice specific to injury populations. We will search Medline, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, websites of government agencies, professional societies and patient advocacy organisations, thesis holdings and conference proceedings. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles using a prepiloted and standardised electronic data abstraction form. Low-value clinical practices will be categorised using an extension of the Agency for Healthcare Research and Quality conceptual framework and data will be presented using narrative synthesis.Ethics and dissemination
Ethics approval is not required as original data will not be collected. This study will be disseminated in a peer-reviewed journal, international scientific meetings, and to knowledge users through clinical and healthcare quality associations. This review will contribute new knowledge on low-value clinical practices in acute injury care. Our results will support the development indicators to measure resource overuse and inform policy makers on potential targets for deadoption in injury care.
SUBMITTER: Moore L
PROVIDER: S-EPMC5726053 | biostudies-literature | 2017 Jul
REPOSITORIES: biostudies-literature
Publications
Low-value clinical practices in injury care: a scoping review protocol.
Moore Lynne L Boukar Khadidja Malloum KM Tardif Pier-Alexandre PA Stelfox Henry T HT Champion Howard H Cameron Peter P Gabbe Belinda B Yanchar Natalie N Kortbeek John J Lauzier François F Légaré France F Archambault Patrick P Turgeon Alexis F AF
BMJ open 20170712 7
<h4>Introduction</h4>Preventable injuries lead to 200 000 hospital stays, 60 000 disabilities, and 13 000 deaths per year in Canada with direct costs of $20 billion. Overall, potentially unnecessary medical interventions are estimated to consume up to 30% of healthcare resources and may expose patients to avoidable harm. However, little is known about overuse for acute injury care. We aim to identify low-value clinical practices in injury care.<h4>Methods and analysis</h4>We will perform a scopi ...[more]
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Project description:INTRODUCTION:Traumatic brain injury (TBI) leads to 50?000 deaths, 85?000 disabilities and costs $60?billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI. METHODS AND ANALYSIS:Using umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). ETHICS AND DISSEMINATION:Ethics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient-partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care. PROSPERO REGISTRATION NUMBER:CRD42019132428.
| S-EPMC6797405 | biostudies-literature
Project description:BACKGROUND:There is recognition that the overuse of procedures, tests and medications strains the healthcare system financially and can cause unnecessary stress and harm to patients. In recent years, several initiatives have targeted the reduction or elimination of low-value practices in healthcare. Research suggests that passive interventions, such as the publication of guidelines, are often not sufficient to change behaviour and that active change interventions - interventions which actively implement strategies to change practices - are required to effect significant, sustained practice change. The purpose of this scoping review is to identify and characterise studies of active change interventions designed to reduce or eliminate low-value healthcare practices. METHODS:We will conduct a review of MEDLINE, EMBASE, CINAHL and Scopus databases from inception. Building on previous research, 40 key terms will be used to search literature. The screening process will be conducted separately by two researchers, with discrepancies resolved by a third. Empirical studies of active change interventions used to reduce or eliminate low-value practices will be included. Descriptive statistics and thematic analysis will be used to categorise the characteristics of the studies. ETHICS AND DISSEMINATION:Ethics approval is not required for this study. This scoping review will provide insights into the impact of several characteristics of active change interventions, including the number of interventions (single-faceted or multifaceted) and the level of implementation (individual or organisational). These results can provide guidance and direction for future research in de-implementation. The results will be disseminated through presentations at national and international conferences and the publication of a manuscript.
| S-EPMC6475168 | biostudies-literature
Project description:BackgroundThe use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. METHOD: A scoping review was conducted according to recommendations outlined by Arksey and O'Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies.ResultsThe scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC.ConclusionsSimilar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes.
| S-EPMC9615304 | biostudies-literature
Project description:IntroductionOrthopaedic injuries affect almost 90% of trauma patients. A previous scoping review and expert consultation survey identified 15 potential low-value intra-hospital practices in the adult orthopaedic trauma population. Limiting the frequency of such practices could reduce adverse events, improve clinical outcomes and free up resources. The aim of this study is to synthesise the evidence on intra-hospital practices for orthopaedic injuries, previously identified as potentially of low value.Methods and analysisWe will search Medline, Excerpta Medica Database (EMBASE), the Cochrane Central Register of Controlled Trials and Epistemonikos to identify systematic reviews, randomised controlled trials (RCTs), quasi-RCTs, cohort studies and case-control studies that evaluate selected practices according to a priori PICOS statements (Population-Intervention-Comparator-Outcome-Study design) . We will evaluate the methodological quality for systematic reviews using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2). Risk of bias in original studies will be evaluated with the Cochrane revised tool for RCTs (RoB2) and with the risk of bias in non-randomised studies of interventions (ROBINS-I) tool. If for a given practice, more than two original studies on our primary outcome are identified, we will conduct meta-analysis using a random effects model and assess heterogeneity using the I2 index. We will assess credibility of evidence (I-IV) based on statistical significance, sample size, heterogeneity and bias as per published criteria.Ethics and disseminationEthics approval is not required as original data will not be collected. Knowledge users from three level I trauma centres are involved in the design and conduct of the study in accordance with an integrated knowledge translation approach. Findings related to the rapid review will be available in May 2020. They will be presented to key stakeholders to inform discussions and raise awareness on low-value injury care. In addition, results will be disseminated in a peer-reviewed journal, at national and international scientific meetings and to healthcare associations.
| S-EPMC7202693 | biostudies-literature
Project description:BackgroundLow-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care.MethodsEvidence sources included MEDLINE, EMBASE, and CINAHL databases from inception to November 26, 2019, grey literature (CADTH Tool), reference lists of included articles, and expert consultation. Citations were screened in duplicate and included if they referred to the public's perception and/or involvement in reducing low-value care. Public included patients or citizens without any advanced healthcare knowledge. Low-value care included medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost-effective. Extracted data pertained to study characteristics, low-value practice, clinical setting, and level of public involvement (i.e., patient-clinician interaction, research, or policy-making).ResultsThe 218 included citations were predominantly original research (n = 138, 63%), published since 2010 (n = 192, 88%), originating from North America (n = 146, 67%). Most citations focused on patient engagement within the patient-clinician interaction (n = 156, 72%), using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Fewer citations examined public involvement in low-value care policy-making (n = 33, 15%). Among citations that examined perspectives regarding public involvement in initiatives to reduce low-value care (n = 10, 5%), there was consistent support for the utility of tools applied within the patient-clinician interaction and less consistent support for involvement in policy-making.ConclusionsEfforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care. This contrasts with inclusion of the public in low-value care policy decisions wherein tools to promote engagement are less well-developed and involvement not consistently viewed as valuable.Trial registrationOpen Science Framework (https://osf.io/6fsxm).
| S-EPMC7137456 | biostudies-literature
Project description:IntroductionEvidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysisA Delphi study will be performed to reach a consensus on the 'Do Not Do' recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected 'Do Not Do' recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and disseminationThe study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration numberThe study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.
| S-EPMC10174026 | biostudies-literature
Project description:Families are significantly impacted by addictions and family involvement in treatment can reduce the harms and can also improve treatment entry, treatment completion and treatment outcomes for the individual coping with an addiction. Although the benefits of family-focused practices in addictions have been documented, services continue to have an individual focus and research on this topic is also limited. The objective of this study is to map the extent, range and nature of evidence available examining family interventions in addictions and identify gaps to guide future research, policy and practice.This is a scoping review using the five-stage framework developed by Arksey and O'Malley. We will include published and unpublished empirical studies focusing on any type of family interventions in addiction treatment between 2000 and the present in English or French. A reviewer will search for literature that meets the inclusion criteria through the following electronic databases: MEDLINE, PsycINFO and Social Services Abstracts. For a comprehensive search, we will also hand-search reference lists, web sites and key journals. Data will be charted and sorted using a thematic analysis approach.This review will be the first to examine all forms of family-focused practices for both substance use and problem gambling treatment for adults. It will provide information about existing service provisions and gaps in practice. This review can be used to start moving towards the development of best practices for families in addiction treatment. The results will be disseminated through a peer-reviewed journal and at mental health and addiction conferences.
| S-EPMC5781095 | biostudies-literature
Project description:BackgroundA considerable proportion of interventions provided to patients lack evidence of their effectiveness. This implies that patients may receive ineffective, unnecessary or even harmful care. However, despite some empirical studies in the field, there has been no synthesis of determinants impacting the use of low-value care (LVC) and the process of de-implementing LVC.AimThe aim was to identify determinants influencing the use of LVC, as well as determinants for de-implementation of LVC practices in health care.MethodsA scoping review was performed based on the framework by Arksey and O'Malley. We searched four scientific databases, conducted snowball searches of relevant articles and hand searched the journal Implementation Science for peer-reviewed journal articles in English. Articles were included if they were empirical studies reporting on determinants for the use of LVC or de-implementation of LVC. The abstract review and the full-text review were conducted in duplicate and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data charting form and the determinants were inductively coded and categorised in an iterative process conducted by the project group.ResultsIn total, 101 citations were included in the review. Of these, 92 reported on determinants for the use of LVC and nine on determinants for de-implementation. The studies were conducted in a range of health care settings and investigated a variety of LVC practices with LVC medication prescriptions, imaging and screening procedures being the most common. The identified determinants for the use of LVC as well as for de-implementation of LVC practices broadly concerned: patients, professionals, outer context, inner context, process and evidence and LVC practice. The results were discussed in relation to the Consolidated Framework for Implementation Research.ConclusionThe identified determinants largely overlap with existing implementation frameworks, although patient expectations and professionals' fear of malpractice appear to be more prominent determinants for the use and de-implementation of LVC. Thus, existing implementation determinant frameworks may require adaptation to be transferable to de-implementation. Strategies to reduce the use of LVC should specifically consider determinants for the use and de-implementation of LVC.RegistrationThe review has not been registered.
| S-EPMC7860215 | biostudies-literature
Project description:IntroductionCardiovascular diseases impose significant financial impact on countries implementing universal health coverage (UHC). Hypertension is a primary disease that will lead to more severe conditions without adequate clinical care. The quality of its clinical care must be well assessed in order to measure the effective coverage of people with hypertension in UHC. This study aims to identify indicators that can be used to measure the quality of clinical care provided to patients with hypertension in healthcare facilities.Methods and analysisThis review will be conducted using the six stages of the scoping review method: identifying the research question, searching for relevant studies, selecting studies, charting the data, collating, summarising and reporting the results, and conducting consultation exercises. The review will include all quality indicators used for clinical care of patients with hypertension at any healthcare facility. All research designs will be included. Search strategies are developed using the medical subject headings and keywords related to hypertension and quality indicators. Several electronic databases, that is, MEDLINE, Cochrane, Scopus and Web of Science, including clinical-guideline databases from Agency for Healthcare Research and Quality, National Institute for Health and Care Excellence, National Health Service Evidence and Medical Information Network Distribution Service, and also grey literature will be used. Two researchers will screen the titles and abstracts and review the full text of selected articles to determine the final inclusion. The results will be summarised quantitatively, using numerical counts, and qualitatively, using thematic analysis. The data extraction will include a complete list and detailed profile of all indicators. Stakeholder consultation will be conducted at the beginning and after preliminary results to translate findings to the potential knowledge users.Ethical considerations and disseminationReviews of published articles are considered secondary analysis and do not need ethical approval. The findings will be disseminated through various strategies, such as policy briefs, conferences, peer-reviewed journals, and on selected websites relevant to the subject.Study statusData collection for the scoping review will include publications up to May 2019, and the analysis will start in June 2019.
| S-EPMC6661615 | biostudies-literature
Project description:BACKGROUND:Nurses make up the largest constituent of the health workforce. The success of health care interventions depends on nurses' ability and willingness to provide quality health care services. A well-implemented performance management (PM) system can be a valuable asset in ensuring that nurses are motivated, promoted, trained and rewarded appropriately. Despite the significant benefits of effective PM such as improved motivation, job satisfaction and morale, PM systems are highly contested. Therefore, it is important to examine evidence on PM methods and practices in order to understand its consequences among nursing professionals in primary health care (PHC) settings. METHODS:The search strategy of this systematic scoping review will involve various electronic databases which include Academic Search Complete, PsycARTICLES. PsycINFO, Cumulative Index to Nursing and Applied Health Literature, Medline and Cochrane Library from the EbsocHost Database Platform. Electronic databases such as PubMed and Google Scholar, Union catalogue of theses and dissertations via SABINET online and WorldCat dissertations will be incorporated. A grey literature search will be conducted on websites such as the World Health Organization and government websites to find relevant policies and guidelines. The period for the search is from 1978 to 2018. This time period was chosen to coincide with the Declaration of Alma-Ata on PHC adopted in 1978. All references will be exported to Endnote library. Two independent reviewers will begin screening for eligible titles, abstracts and full articles. During title and abstract screening, duplicates will be removed. The Mixed Method Appraisal Tool will determine the quality of included studies. Thematic analysis will be used to analyse the included articles. DISCUSSION:Evidence of preferences on PM methods and practices will generate insight on the use of PM systems in PHC and how this can be used for the purpose of improving nurses' performance and in turn, the provision of quality health care. We hope to expose knowledge gaps and inform future research.
| S-EPMC7035770 | biostudies-literature